Traumatic central cord syndrome: analysis of factors affecting the outcome

Yamazaki, Takahisa; Yanaka, Kiyoyuki; Fujita, Keishi; Kamezaki, Takao; Uemura, Kazuya; Nose, Tadao

doi:10.1016/j.surneu.2004.03.020

Cited by 97 publications

(102 citation statements)

References 10 publications

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“…Therefore, extrapolation of these results to the human clinical situation is doubtful since in patients surgical decompression is rarely preformed within several hours, the injury is never standardized and there is no diagnostic means to determine the exact type and severity of the neurologic injury. Nevertheless, several LOE I and II clinical studies support these findings in patients with spinal cord injury [17,18,28,35,39,55] and reviews recommend early surgery in spinal cord injury [2,16,36,41,44]. But there are also articles that report no difference in neurological outcome between early and late decompression [22,42,54].…”

Section: Discussionmentioning

confidence: 98%

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

2006

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Abstracts A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.

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Section: Discussionmentioning

confidence: 98%

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

2006

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“…Recently, several papers in the literature have suggested potential benefits of early surgical treatment in selected cases, leading to controversy and wide variations in management. 5,11,16,26 Bose et al 3 retrospectively compared data obtained in 14 surgical and 14 nonsurgical patients and found that higher motor scores at discharge were recorded in the surgical group; however, the follow-up period was short and significant selection bias limited their conclusion. From the existing literature, it is difficult to make comparisons among these studies because of the variabilities in clinical manifestation, treatment options, and outcome measurements.…”

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confidence: 99%

Effectiveness of surgical treatment for traumatic central cord syndrome

Chen¹,

Yang²,

Tong-qi³

et al. 2009

SPI

103

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Object The authors undertook a study in patients with traumatic central cord syndrome (TCCS) who underwent surgical intervention. They retrospectively assessed the motor score improvement and functional status and identified prognostic predictors of improvement. Methods Between March 1999 and May 2004, 49 patients with TCCS were surgically treated. Motor scores were collected at admission and follow-up using the American Spinal Injury Association (ASIA) Impairment Scale. The 36-Item Short Form Health Survey (SF-36) was administered. Other parameters including walking index, spasticity, bladder management, and neuropathic pain scores were recorded. Patients were asked to assess their level of satisfaction with their final symptoms. Results The average ASIA score, converted into numeric values, was increased from 54.9 at admission to 81.9 and 89.6 at 6 months and final follow-up, respectively. Significant improvement of ASIA score was achieved within the first 6 months of surgery. No significant difference was found between patients who underwent surgery within 4 days of injury or after 4 days of injury, adopting different approaches (anterior, posterior, or a combination), or with different pathological entities (acute disc herniation, fracture or dislocation, or multilevel degeneration). The ASIA score improvement had a positive correlation with the age at injury (r = 0.505, p = 0.023). The SF-36 data at 6 months and final follow-up were not as satisfactory as the improvement in ASIA scores, and almost one-third of patients expressed dissatisfaction with their final symptoms. For patients who were older than 65 years at injury, the mean follow-up Walking Index for Spinal Cord Injury (WISCI) score was statistically lower than it was in younger patients. The presence of spasticity or neuropathic pain at follow-up was not related to age, sex, ASIA motor score, or WISCI outcome. Conclusions Surgical intervention can be safely applied in patients with TCCS. Significant improvement of ASIA score was achieved during the first 6-month period of follow-up. Factors including type of lesion, timing of surgery within or after 4 days of injury, and surgical approach were not significantly associated with final ASIA score. The improvement in the ASIA motor score was positively correlated with age at injury. No significant correlation was found between or among the presence of spasticity, neuropathic pain, and ASIA score at final visit. Almost one-third of patients were not satisfied with their final symptoms.

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“…Therefore, they recommended a "watch and wait" strategy in patients without cervical instability. Other authors recommended early surgery because it led to rapid neurological recovery and shorter hospitalization (16) or because the more stenotic canal caused a worse outcome (17). We prefer to perform early decompression if the general status of the patient allows.…”

Section: Discussionmentioning

confidence: 99%

Cervical spinal cord injury in patients with cervical canal stenosis without radiologic evidence of trauma: evaluation of 15 consecutive cases

Eren¹,

Tufan²,

Çetin³

et al. 2017

Bagcilar Medical Bulletin

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Objective: Cervical spinal canal stenosis is a well-known risk factor for spinal cord injury. In some patients, spinal cord injury is the first symptom of spinal stenosis. Therefore, some authors recommend preventive decompression of the spinal canal in asymptomatic patients with spinal stenosis. In this study, we aimed to determine the outcome of patients with spinal cord injury associated with cervical spinal canal stenosis and the rate of previously asymptomatic patients. Material and Methods: Data of 15 consecutive patients were evaluated. Improvement of neurological deficits during followup was accepted as good outcome and mortality and unchanging neurological deficits were accepted as worse outcome. Results: All patients were male, aged between 44 and 85 years. High-energy traumas caused injury in 7 of the cases and low-energy traumas in the others. Nine cases had central cord injury and 6 had other types of traumas. Only 2 patients had been diagnosed with minor symptoms associated with cervical canal stenosis before trauma, while the other patients had been asymptomatic. One patient did not consent to undergo an operation and two others could not be operated because of their general status; the latter 2 patients died. The other 12 patients were decompressed 0 to 40 days after trauma. Two other patients with severe transverse-type cord injury also died postoperatively. The other patients were followed for 1 to 48 months (22.7±17.7 months). In 2 patients, neurological deficits had not improved on last follow-up. Deficits had completely or partly improved in the other patients, including the one who had not accepted the operation. Central cord injury had a significantly better prognosis than other types (p=0.0019). Age, cervical canal diameter, and motor and sensory scores of the American Spinal Injury Association scale, type of trauma, and level of spinal cord injury were not significantly different in the patients with good and worse prognosis. Conclusion:The rate of asymptomatic patients before trauma was very high in patients with spinal cord injury associated with cervical spinal canal stenosis. Therefore, the treatment decision must be carefully assessed in asymptomatic cervical spinal stenosis patients. Catastrophic consequences of spinal trauma may be seen in patients with cervical spinal canal stenosis even in asymptomatic patients. Central cord syndrome had a good prognosis in these patients. Other types of injuries such as transverse and motor types had a worse outcome. Keywords: cervical spinal canal stenosis, spinal cord injuries, spinal cord trauma ÖZET Servikal dar kanal hastalarında radyolojik travma bulgusu olmaksızın servikal omurilik yaralanması: Ardışık 15 olgunun değerlendirilmesi Amaç: Servikal spinal dar kanal omurilik yaralanması için iyi bilinen bir risk faktörüdür. Bazı olgularda kanal darlığının ilk belirtisi omurilik yaralanması olabilir. Bu nedenle bazı yazarlar kanal darlığı olan belirtisiz olgularda önleyici amaçla dekompresyon önermektedir. Bu çalışmada servikal dar ka...

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Traumatic central cord syndrome: analysis of factors affecting the outcome

Cited by 97 publications

References 10 publications

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

Effectiveness of surgical treatment for traumatic central cord syndrome

Cervical spinal cord injury in patients with cervical canal stenosis without radiologic evidence of trauma: evaluation of 15 consecutive cases

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